Commentary

Crucial Concussion Evaluation Info for Coaches

By Dev K. Mishra, M.D.

How should a coach evaluate a young athlete for a possible concussion?

The key word in that first sentence is “possible,” meaning that a coach who is not medically trained should not make the definitive diagnosis of a concussion. Your job is to assess the athlete and determine whether you suspect a concussion, remove that athlete from play, and send the athlete for evaluation by a medical professional trained in sports concussion management.

I highly recommend the Pocket Concussion Recognition Tool, which you can download HERE.

If your athlete has taken contact and has any one of the features noted on the card you should suspect a concussion and remove the athlete from play:

SYMPTOMS:
* Loss of consciousness
* Seizure or convulsion
* Amnesia
* Headache
* “Pressure in head”
* Neck Pain
* Nausea or vomiting
* Dizziness
* Blurred vision
* Balance problems
* Sensitivity to light
* Sensitivity to noise
* Feeling slowed down
* Feeling like “in a fog“
* “Don’t feel right”
* Difficulty concentrating
* Difficulty remembering
* Fatigue or low energy
* Confusion
* Drowsiness
* More emotional
* Irritability
* Sadness
* Nervous or anxious

If the athlete is unconscious, do not move, shake, or attempt to rouse the athlete. Call for emergency medical transportation immediately. Stay with the athlete until help arrives. If the athlete is unconscious it is a medical emergency.

As our knowledge about concussion has improved it’s clear to us that the definition of concussion needs to change. Long gone are the days when an athlete needed to be knocked unconscious or close to unconscious before it was deemed a concussion.

We know now that even a headache that happens after contact to the player’s head, player’s body, or by the ground to the player’s body can be an early indicator of a concussion. Essentially, the definition of concussion is quite a bit broader than it once was.

What that means for the coach is that there are going to be a lot more suspected concussions. It means that you’ll likely deal with situations where you’ll ask yourself questions such as “it’s just a headache, do I really have to hold this player out after something like that?”

My advice to you: yes, you need to hold that player out of practice or competition and the player should seek medical attention urgently.

Use your best judgment and be overly cautious.

The final phrasing on the Pocket Concussion Recognition Tool says what you need very clearly:

"Any athlete with a suspected concussion should be IMMEDIATELY REMOVED FROM PLAY, and should not be returned to activity until they are assessed medically. Athletes with a suspected concussion should not be left alone and should not drive a motor vehicle."

(Dr. Dev K. Mishra is the creator of the SidelineSportsDoc.com injury management program for coaches. He is a Clinical Assistant Professor of orthopedic surgery at Stanford University. Mishra writes about injury management at SidelineSportsDoc.com Blog, where this article first appeared.)

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